Association between frailty and depressive symptoms in patients with cancer: A meta-analysis

Frailty and depression commonly coexist in patients with cancer, potentially compounding its vulnerability, and affecting outcomes. However, the strength of its association remains uncertain. This meta-analysis aims to evaluate the relationship between frailty and depressive symptoms in adults with cancer.

The PubMed, Embase, and Web of Science databases were systematically searched up to February 19, 2025 for observational studies that compared depression prevalence between frail and non-frail patients with cancer. The random-effects model was used to pool the odds ratios (ORs) and 95% confidence intervals (CIs).

Thirteen cross-sectional studies that involved 7037 patients with cancer were included. The pooled analysis revealed that frailty was significantly associated with higher odds of depression (OR: 5.79, 95% CI: 4.31-7.77, p < 0.001), with moderate heterogeneity (I² = 63%). By excluding one study at a time, the sensitivity analyses yielded consistent results (the ORs ranged within 5.43-6.39). The subgroup analyses indicated generally consistent trends across regions (Asian vs. Western countries), age groups (<70 vs. ≥70 years), genders, frailty assessment methods, depression diagnostic tools, analytic models (univariate or multivariate), and study quality scores (all p for subgroup difference > 0.05). However, these findings should be considered exploratory and interpreted with caution due to the limited studies in each subgroup. The Egger's test results revealed no significant publication bias (p = 0.72).

Frailty may be associated with depressive symptoms in patients with cancer across diverse populations and assessment methods. Routine screening for depression in frail patients with cancer may support early intervention and improve comprehensive care.